QUI-PAT-72

Code
QUI-PAT-72
Mercy ID
V-03405-01
Encounter Date
09/02/2010
Last
Quiroz
First
Patricia
DOB
05/25/1972
County
Fulton
Street
4717 Roswell Road Apt. E-1
City
Atlanta
State
GA
Zip
30342-
Cell
(404) 437-4233
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Herrera
First
Roberto
DOB
08/21/1972
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
No
Consentimiento De Participar
No

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Angie Gama 02/28/1996 Mother GA/USA
Gael Gama 06/06/2007 Mother GA/USA
Heidy Gama 02/28/1995 Mother GA/USA

Former Spouse 1 Information

Last
Gama
First
Raul
DOB
03/16/1971
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
Juana's cell